Candida albicans empyema in COVID-19 infected patient: The first reported case in Qatar

Abstract

Background: COVID-19 infection is caused by a novel coronavirus. It was identified initially in late 2019 as the cause of a cluster of pneumonia cases in Wuhan, China. It spread worldwide causing a pandemic. Since the start of the COVID-19 pandemic, multiple complications have been linked to COVID-19 infections, one of them being pleural effusion. To the best of our knowledge, only a few case reports have discussed the incidence of candida empyema in COVID-19 patients1,2. Case Presentation: This work is reporting on a case of COVID-19 pneumonia, in a 52-year-old previously healthy male patient, who developed ARDS 2 days after diagnosis of COVID-19 pneumonia and was attached to mechanical ventilation. Unfortunately, he continued to progress with refractory hypoxemia despite the maximum support. Ultimately, the patient required veno-venous ECMO with ultra-protective lung ventilation until the gas exchange in his lungs has normalized. The patient received multiple treatments based on our local protocol that have immunosuppressive effects. Due to worsening pneumonia, bronchoscopy was done. The Bronchoalveolar lavage (BAL) showed Candida Albicans, which was complicated with left-sided candida empyema. The later was treated by antifungal, chest tube insertion, and finally with decortication. However, despite the maximum interventions, the patient has unfortunately passed away 2 weeks after the decortication due to sepsis and multi-organ failure, while he was on ECMO during the whole period. Recommendation: Given the immunosuppressive effect of many of the medications used for the treatment of COVID-19 infection, atypical and opportunistic infections should be carefully considered within the clinical context. Conclusion: Candida pneumonia/empyema is not very common in a healthy host, however, it is a serious and rare condition, commonly seen in immunocompromised patients and associated with a high mortality rate3. The immunosuppressive therapies that are used in COVID-19 are not completely safe and more atypical infectious agents have been considered as not suitable in several typical locations causing adverse outcomes.